More than one-third of US high school seniors report past-month alcohol consumption, and alcohol contributes to the top 3 causes of death among youth: unintentional injury (most of which are motor vehicle accidents), homicide, and suicide. Intervening early in adolescent substance use is critical because it can improve the life course trajectory of addiction and its harms. Because only 1 in 10 adolescents who need treatment of an alcohol use problem actually receive it, waiting for youth to seek help from a provider is not an effective strategy. To detect alcohol use and intervene early, major organizations,5–7  including the American Academy of Pediatrics, recommend routine alcohol screening, brief intervention (BI), and referral to treatment (SBIRT) for adolescents and young adults.

Interpreting the evidence base for SBIRT is complex. Study designs can vary by substance (alcohol, drugs, or both), outcome (reduction in consumption,...

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